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4175 Beaver Dam Rd - ME96140)off 5 5 ao Date: Site Address: Tenant: RESIDENT / OWNER CONTRACTOR TYPE OF WORK PERMIT TYPE Applicant's Printed Name City atBaQali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Staff: 2010 MECHANICAL PERMIT APPLICATION LI I E &fig KM RC) A 0 Date Received: Permit #: `ai'O Permit Fee: '4 Suite #: Use BLUE or BLACK Ink Name: FRANK LID lS tit c-A-J Phone: tD X 5L 1-0$O Address / City / Zip: 411-5 BtRor-5 bNll R 1 ZIN6 /& i+t). 551 Name: Ft-Aft-et. \"k'LAIIfUUA' �C- LUL., License #: 1 ' 4 10 2 -S -1 -- 1 - 0 Address: g3d.s `1't.y�c7ll'T - )\)2 M 10 City: bOLD`t.iV ONLASt- State: t' do Zip: ` 54 'Li Phone: 1(.0 5 4 Z- I l (y to Contact %a.1.)C .. VO U& Email: iA.Ca� 1..O.fthE' 't t „ t7 Description of work: NOTE: Roo ) de. Pie mou finical / RESIDENTIAL N/ Furnace Conditioner Air Exchanger Heat Pump Other New Replacement Additional Alteration Demolition and hanicai equip_ information on New Construction _ Install Piping Gas RESIDENTIAL FEES: $50.50 Minimum Add -on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) COMMERCIAL _ Interior Improvement Processed Exterior HVAC Unit Under / Above ground Tank ( Install /_ Remove) ** When installing /removing tank(s), call for inspection by Fire Marshal and Plumbing Inspector 55•Co® TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation /removal OR Contract Value $ x 1% $50.50 Minimum (includes State Surcharge) = $ Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge $1,000 Permit Fee (i.e. a $1,001 - $2,000 Permit Fee requires a $1.00 surcharge). _ $ TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecafl.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit that the work will be, in accordance with the approved plan in the case of work which requires a review and approval of plans. x bQ0 W+5 i NorvlPSoiV x Applicant's Signature Reviewed` Air T est Ges SE AC s creening inspe